Quality of Research
Documents Reviewed
The documents below were reviewed for Quality of Research. The research point of
contact can provide information regarding the studies reviewed and the availability
of additional materials, including those from more recent studies that may have been conducted.
Study 1Ford, J. D., & Hawke, J. (in press). Trauma Affect Regulation psychoeducation group attendance is associated with reduced disciplinary incidents and sanctions in juvenile detention facilities. Journal of Child and Adolescent Trauma.
Supplementary Materials Evans, E., Grella, C. E., Murphy, D. A., & Hser, Y. I. (2010). Using administrative data for longitudinal substance abuse research. Journal of Behavioral Health Services and Research, 37(2), 252-271. 
Finkelhor, D., & Wells, M. (2003). Improving data systems about juvenile victimization in the United States. Child Abuse and Neglect, 27(1), 77-102.
Sedman, A., Harris, J. M., II, Schulz, K., Schwalenstocker, E., Remus, D., Scanlon, M., et al. (2005). Relevance of the Agency for Healthcare Research and Quality Patient Safety Indicators for children's hospitals. Pediatrics, 115(1), 135-145.
Outcomes
| Outcome 1: Disciplinary incidents |
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Description of Measures
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Disciplinary incidents were assessed using data abstracted from the daily documentation of behavioral incidents at three separate Connecticut juvenile detention facilities. The facilities' administrative records data were collected on a deidentified basis (i.e., all identifying information, such as name and address, was removed, and youth were assigned unique identification numbers).
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Key Findings
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Data from youth who received TARGET in a juvenile detention facility were compared with data from a matched control group of youth who were in a juvenile detention facility but did not receive TARGET. Controlling for the effects of site (i.e., specific detention center), length of stay, age, gender, ethnicity, type and severity of legal charges, trauma history, behavioral health problem severity, and original versus improved data management system, the study found that each session of TARGET received by youth in the first 14 days of detention was associated with a decrease in the number of reported disciplinary incidents relative to the number of incidents reported for the control group (p < .001).
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Studies Measuring Outcome
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Study 1
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Study Designs
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Quasi-experimental
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Quality of Research Rating
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3.0
(0.0-4.0 scale)
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| Outcome 2: Disciplinary sanctions |
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Description of Measures
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Disciplinary sanctions were assessed using data abstracted from the daily documentation of minutes spent in "room time" (i.e., being removed from the community milieu as a consequence of a behavioral incident) at three separate Connecticut juvenile detention facilities. The facilities' administrative records data were collected on a deidentified basis (i.e., all identifying information, such as name and address, was removed, and youth were assigned unique identification numbers).
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Key Findings
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Data from youth who received TARGET in a juvenile detention facility were compared with data from a matched control group of youth who were in a juvenile detention facility but did not receive TARGET. Controlling for the effects of site (i.e., specific detention center), length of stay, age, gender, ethnicity, type and severity of legal charges, trauma history, behavioral health problem severity, and original versus improved data management system, the study found that each session of TARGET received by youth in the first 14 days of detention was associated with a decrease in disciplinary sanctions relative to the sanctions for the control group (p < .001).
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Studies Measuring Outcome
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Study 1
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Study Designs
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Quasi-experimental
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Quality of Research Rating
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3.0
(0.0-4.0 scale)
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| Outcome 3: Recidivism |
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Description of Measures
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Recidivism (defined as an arrest in the 6 months after a youth's release into the community from juvenile detention) was assessed using administrative data extracted from juvenile court records on a deidentified, redacted basis.
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Key Findings
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Controlling for the effects of site (i.e., specific detention center), length of stay, age, gender, ethnicity, type and severity of legal charges, trauma history, behavioral health problem severity, and original versus improved data management system, the study found that after the improved data management system was instituted, participation by youth in TARGET was associated with a lack of recidivism compared with youth in the control group (p = .03). However, the number of TARGET sessions attended did not have a significant effect on recidivism.
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Studies Measuring Outcome
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Study 1
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Study Designs
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Quasi-experimental
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Quality of Research Rating
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3.2
(0.0-4.0 scale)
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Study Populations
The following populations were identified in the studies reviewed for Quality of
Research.
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Study
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Age
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Gender
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Race/Ethnicity
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Study 1
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13-17 (Adolescent)
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90.9% Male
9.1% Female
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43% Black or African American
32.5% Hispanic or Latino
24.5% White
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Quality of Research Ratings by Criteria (0.0-4.0 scale)
External reviewers independently evaluate the Quality of Research for an intervention's
reported results using six criteria:
For more information about these criteria and the meaning of the ratings, see Quality of Research.
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Outcome
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Reliability
of Measures
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Validity
of Measures
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Fidelity
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Missing
Data/Attrition
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Confounding
Variables
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Data
Analysis
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Overall
Rating
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1: Disciplinary incidents
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2.9
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2.8
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2.9
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3.9
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2.6
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3.1
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3.0
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2: Disciplinary sanctions
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2.9
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2.8
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2.9
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3.9
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2.6
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3.1
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3.0
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3: Recidivism
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3.6
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3.4
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2.9
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3.9
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2.6
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2.6
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3.2
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Study Strengths The outcome data for recidivism were abstracted from official juvenile court administrative records, which are likely to be reliable and valid. Efforts were undertaken to ensure that the intervention was implemented with fidelity (e.g., observation of delivery, use of a fidelity checklist). A quasi-experimental design was used, and matching was employed in an attempt to equate the intervention and control groups. The multivariate analysis controlled for variables that were not equated during the matching procedures or were associated with the number of intervention sessions a youth received.
Study Weaknesses There is no evidence that the administrative records data from the three detention facilities have high reliability, although it is assumed that similar procedures were used at each facility to record disciplinary incidents and sanctions. It is unclear whether the staff who reported disciplinary incidents and determined sanctions were blind to the intervention status of participants. Although intervention fidelity was addressed, only one observer confirmed that sessions adhered to the curriculum. The small number of youth who were arrested in the 6 months after release from detention limited the power of the sample size to detect an association between the number of intervention sessions received and recidivism.
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Review Date: October 2007
Documents Reviewed
The documents below were reviewed for Quality of Research. The research point of
contact can provide information regarding the studies reviewed and the availability
of additional materials, including those from more recent studies that may have been conducted.
Study 1Frisman, L., Ford, J., Mallon, S., & Chang, R. (2007). Outcomes of trauma treatment using the TARGET model. Manuscript submitted for publication. Study 2Ford, J. D., Steinberg, K. L., Moffitt, K. H., & Zhang, W. A randomized clinical trial of affect regulation and social problem solving psychotherapies for low income mothers with PTSD: The Mothers Overcoming and Managing Stress (MOMS) study. Manuscript in preparation.
Ford, J., Tennen, H., Steinberg, K., & Moffitt, K. H. (2007, August). Randomized trial of complex PTSD psychotherapy with low-income young mothers. Report presented at the American Psychological Association's 115th annual convention. San Francisco.
Supplementary Materials Chapman, J. F., Ford, J., Albert, D., Hawke, J., & St. Juste, M. C. (2006). The TARGET approach: Taking the fear out of trauma services. Correct Care, 20(2), 1, 14.
Ford, J. D., & Hawke, J. Demonstration of a promising evidence-informed multimodal trauma recovery intervention (TARGET) for girls and boys in juvenile detention programs. Manuscript in preparation.
Ford, J. D., & Russo, E. (2006). Trauma-focused, present-centered, emotional self-regulation approach to integrated treatment for posttraumatic stress and addiction: Trauma Adaptive Recovery Group Education and Therapy (TARGET). American Journal of Psychotherapy, 60(4), 335-355.
Ford, J. D., Russo, E. M., & Mallon, S. D. (2007). Integrating post-traumatic stress disorder and substance use disorder treatment. Journal of Counseling and Development, 85, 475-490.
Ford, J. D., Steinberg, K. L., Moffitt, K. H., & Zhang, W. A randomized clinical trial of affect regulation psychotherapy for delinquent girls: The Girls' In Recovery from Life Stress (GIRLS) study. Manuscript in preparation.
Reliability and Validity of Study Outcome Measures: Frisman et al. Study of TARGET vs. Enhanced Treatment as Usual
Reliability and Validity of Study Outcome Measures: MOMS Study of TARGET vs. PCT vs. Wait-List TAU
Outcomes
| Outcome 1: Severity of posttraumatic stress disorder (PTSD) symptoms |
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Description of Measures
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The severity of PTSD symptoms was measured using the Traumatic Stress subscale of the Global Appraisal of Individual Needs (GAIN), a self-report questionnaire. The 14 items in the subscale assess an individual's perceived problems related to memories of the past. Another measure used was the Clinician-Administered PTSD Scale (CAPS), a structured interview that generates ordinal symptom severity scores for PTSD. The CAPS scores the intensity and frequency of each PTSD symptom.
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Key Findings
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In one study, TARGET participants showed a greater improvement in the severity of PTSD symptoms at posttreatment than participants in the wait-list control group and the patient-centered psychoeducational therapy group. The effect sizes were medium (Cohen's d = 0.75) and very small (Cohen's d = 0.15), respectively.
In another study that compared TARGET with trauma-sensitive usual care, no statistically significant difference was found in the severity of PTSD symptoms between the two groups.
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Studies Measuring Outcome
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Study 1, Study 2
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Study Designs
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Experimental
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Quality of Research Rating
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3.3
(0.0-4.0 scale)
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| Outcome 2: PTSD diagnosis |
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Description of Measures
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PTSD diagnosis was assessed using the CAPS, a structured interview for DSM-IV categorical diagnosis of PTSD and partial PTSD.
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Key Findings
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Sixty-three percent of TARGET participants with a PTSD diagnosis at intake did not meet the criteria for a PTSD diagnosis at posttreatment, compared with 33% in the wait-list control group (p < .005). No statistically significant difference in PTSD diagnosis was found between TARGET participants and participants in the patient-centered psychoeducational therapy group.
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Studies Measuring Outcome
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Study 2
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Study Designs
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Experimental
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Quality of Research Rating
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3.3
(0.0-4.0 scale)
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| Outcome 3: Negative beliefs related to PTSD and attitudes toward PTSD symptoms |
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Description of Measures
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Negative beliefs related to PTSD and attitudes toward PTSD symptoms were measured using the Post-Traumatic Cognitions Inventory (PTCI) and the Interpretation of PTSD Symptoms Inventory (IPSI). The PTCI is a 36-item scale that assesses the strength of posttraumatic beliefs about oneself and the world that have been shown to interfere with psychosocial functioning and problem solving. The IPSI is a 10-item scale that measures distress concerning both unwanted trauma memories (intrusive symptoms) and problems in remembering a traumatic event (memory deficits).
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Key Findings
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In one study, TARGET participants showed a greater improvement in beliefs and attitudes at posttreatment than participants in the wait-list control group and the patient-centered psychoeducational therapy group. Effect sizes were small to medium (Cohen's d = 0.46 to 0.54) and very small (Cohen's d = 0.12), respectively.
In another study that compared TARGET with trauma-sensitive usual care, no statistically significant difference was found in beliefs and attitudes between the two groups.
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Studies Measuring Outcome
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Study 1, Study 2
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Study Designs
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Experimental
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Quality of Research Rating
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3.3
(0.0-4.0 scale)
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| Outcome 4: Severity of anxiety and depression symptoms |
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Description of Measures
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Severity of anxiety and depression symptoms was measured using the GAIN's Anxiety subscale, which can be used to diagnose generalized anxiety disorder, and Depression subscale, which can be used to identify levels of depression. Other measures used were the State-Trait Anxiety Inventory, State Version, which assesses the strength of 20 psychological, cognitive, affective, and behavioral symptoms of anxiety in the immediate moment, and the Beck Depression Inventory, which assesses depressive symptoms using 21 items, each of which has four possible answers with behavioral indices.
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Key Findings
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In one study, TARGET participants showed a greater improvement in depression symptoms at posttreatment than participants in the wait-list control group. The effect size was small (Cohen's d = 0.25). TARGET participants showed a greater improvement in anxiety symptoms at posttreatment than participants in the wait-list control group and the patient-centered psychoeducational therapy group, with effect sizes that were small (Cohen's d = 0.39) and very small (Cohen's d = 0.16), respectively. From the 3- to 6-month follow-up, TARGET participants showed greater improvement in severity of anxiety symptoms than participants in the patient-centered psychoeducational therapy group (p < .05).
In another study that compared TARGET with trauma-sensitive usual care, no statistically significant difference was found in the severity of anxiety and depression symptoms between the two groups.
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Studies Measuring Outcome
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Study 1, Study 2
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Study Designs
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Experimental
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Quality of Research Rating
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3.3
(0.0-4.0 scale)
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| Outcome 5: Self-efficacy related to sobriety |
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Description of Measures
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Self-efficacy related to sobriety was measured using the GAIN's Self-Efficacy Index, which assesses an individual's self-confidence about resisting relapse of alcohol use in different situations.
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Key Findings
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TARGET participants maintained their level of self-efficacy related to sobriety throughout the follow-up periods (3 and 6 months), while participants in trauma-sensitive usual care showed a significant decline in self-efficacy (p = .027).
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Studies Measuring Outcome
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Study 1
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Study Designs
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Experimental
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Quality of Research Rating
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2.8
(0.0-4.0 scale)
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| Outcome 6: Emotion regulation |
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Description of Measures
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Emotion regulation was measured using the Generalized Expectancies for Negative Mood Regulation, a 30-item scale that assesses self-perceived ability to identify, manage, and adaptively use a variety of negative mood states. Individuals use a 5-point scale from "strongly agree" to "strongly disagree" to respond to items beginning with the phrase, "When I feel upset, I . . . ."
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Key Findings
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At posttreatment, TARGET participants showed a greater improvement in emotion regulation than participants in the wait-list control group and the patient-centered psychoeducational therapy group. The effect sizes were medium (Cohen's d = 0.75) and small (Cohen's d = 0.33), respectively.
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Studies Measuring Outcome
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Study 2
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Study Designs
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Experimental
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Quality of Research Rating
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3.3
(0.0-4.0 scale)
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| Outcome 7: Health-related functioning |
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Description of Measures
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Health-related functioning was measured using the Medical Outcomes Study Short Form-12, a 12-item questionnaire that assesses overall self-perceived physical health and well-being (e.g., global health, ability to manage physical and emotional health problems and pain).
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Key Findings
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At the 6-month follow-up, TARGET participants showed improvement in health-related functioning compared with participants in the patient-centered psychoeducational therapy group (p < .05). No statistically significant difference in health-related functioning was found between TARGET participants and participants in the wait-list control group.
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Studies Measuring Outcome
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Study 2
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Study Designs
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Experimental
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Quality of Research Rating
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3.3
(0.0-4.0 scale)
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Study Populations
The following populations were identified in the studies reviewed for Quality of
Research.
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Study
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Age
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Gender
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Race/Ethnicity
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Study 1
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26-55 (Adult)
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61% Female
39% Male
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56% White
24% Black or African American
10% Hispanic or Latino
10% Race/ethnicity unspecified
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Study 2
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18-25 (Young adult)
26-55 (Adult)
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100% Female
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39% White
33% Black or African American
28% Race/ethnicity unspecified
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Quality of Research Ratings by Criteria (0.0-4.0 scale)
External reviewers independently evaluate the Quality of Research for an intervention's
reported results using six criteria:
For more information about these criteria and the meaning of the ratings, see Quality of Research.
|
Outcome
|
Reliability
of Measures
|
Validity
of Measures
|
Fidelity
|
Missing
Data/Attrition
|
Confounding
Variables
|
Data
Analysis
|
Overall
Rating
|
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1: Severity of posttraumatic stress disorder (PTSD) symptoms
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4.0
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4.0
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3.0
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3.3
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3.0
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2.5
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3.3
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2: PTSD diagnosis
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4.0
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4.0
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3.0
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2.5
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3.5
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2.5
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3.3
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3: Negative beliefs related to PTSD and attitudes toward PTSD symptoms
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4.0
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4.0
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3.0
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3.3
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3.0
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2.5
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3.3
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4: Severity of anxiety and depression symptoms
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4.0
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4.0
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3.0
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3.3
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3.0
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2.5
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3.3
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5: Self-efficacy related to sobriety
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3.5
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3.5
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2.0
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3.5
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1.5
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2.5
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2.8
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6: Emotion regulation
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4.0
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4.0
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3.0
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2.5
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3.5
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2.5
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3.3
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7: Health-related functioning
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4.0
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4.0
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3.0
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2.5
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3.5
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2.5
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3.3
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Study Strengths The studies were well designed and employed standardized and widely used outcome measures with good to excellent psychometric properties. The intervention model was structured and manualized. A fidelity checklist was developed and used in the studies.
Study Weaknesses There are a number of confounding variables that make it difficult to attribute differences in outcomes to the study intervention. For example, a significant number of study participants did not receive the full treatment intervention; attrition rates were high; the sample size was small; convenience samples were used, increasing the possibility of selection bias; and the study did not include a placebo control. Results of the intent-to-treat analysis are questionable due to the low intervention completion rate.
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